RESUMO
OBJECTIVE: To compare the blood loss between intra-articular and intra-venous administration of tranexamic acid (TXA) in patients undergoing primary total knee arthroplasty. DESIGN OF STUDY: It was a randomized controlled trial. Study duration and settings: This study was carried out at the Orthopedic Departments of Combined Military Hospital Lahore and Rawalpindi from Jan 2016 to March 2018. METHODOLOGY: Patients of both the genders were involved this study who had age in the rage of 40-80 years undergoing primary unilateral total knee arthroplasty for degenerative conditions like osteoarthritis and rheumatoid arthritis. These patients were randomly divided into two treatment groups. Patients in IA group received intra-articular tranexamic acid while those in IV group received intravenous tranexamic acid. From all the patients, a written signed consent was taken. FINDINGS: Females were predominant with male-to-female ratio of 1:3.7. The mean age of the patients was 67.3 ± 8.2 years while the mean BMI was 30.9 ± 2.9 Kg/m2. Majority (n = 191, 95.5%) of the patients had osteoarthritis while remaining 9 (4.5%) patients had rheumatoid arthritis. There was no statistically significant difference between intra-articular and intra-venous administration of tranexamic acid in terms of mean post-operative hemoglobin (9.93 ± 1.14 vs. 9.87 ± 1.26 g/dL; p-value = 0.724), mean post-operative hematocrit (34.8 ± 1.66 vs. 34.73 ± 1.27%; p-value = 0.594), and mean fall in hemoglobin (2.27 ± 0.34 vs. 2.25 ± 0.30 g/dL; p-value = 0.587) and hematocrit (2.34 ± 0.94 vs. 2.46 ± 0.28%; p-value = 0.216). CONCLUSION: Intra-articular administration of tranexamic acid was found to be as effective and safe as intra-venous administration in reducing blood loss in primary total knee arthroplasty. Due to convenience, the use of intra-articular administration of tranexamic acid after primary TKA may be considered in future practice.
RESUMO
OBJECTIVE: To determine the radiological, functional, and anatomical outcome in patients with osteoarthritic knee undergoing high tibial osteotomy (HTO). DESIGN OF STUDY: Descriptive case series. Study duration and settings: The present study was a descriptive case series carried out at the Orthopedic Departments of District Head Quarter Hospital Faisalabad affiliated with Faisalabad Medical University, Faisalabad from Jan 2014 to March 2018. METHODOLOGY: This study involved 40 patients of both genders, aged between 40 and 65 years having advanced degenerative disease of knee limited to medial compartment of joint. These patients were treated by medial open wedge high tibial osteotomy (OWHTO) and outcome was evaluated after 5 years of surgery in terms of radiological knee mechanics, functional outcome scores, and arthroscopic evidence of cartilage regeneration in the medial compartment. A signed written consent was taken from every patient. FINDINGS: There was a female predominance with a male-to-female ratio of 1:4. The mean age of the patients was 53.2 ± 6.9 years. The values of the radiographic parameters significantly changed from pre-operative condition after HTO; mechanical tibiofemoral angle [MTFA, (-8.1 ± 1.2° vs. 2.5 ± 1.2°; p-value < 0.0001)], tibial plateau inclination [TPI, (5.3 ± 1.1° vs. 3.4 ± 1.1°; p-value < 0.0001)], knee joint line orientation relative to the ground [G-KJLO, (0.3 ± 0.1° vs. 4.6 ± 1.5°; p-value < 0.0001)], and ankle joint line orientation relative to the ground [G-AJLO (8.3 ± 3.2° vs. 2.3 ± 1.7°; p-value < 0.0001)]. There was significant improvement in patient's functional status; KOOS-ADL score (45.5 ± 7.8 vs. 73.7 ± 8.6; p-value < 0.0001), International Knee Documentation Committee (IKDC) score (42.4 ± 6.9 vs. 68.5 ± 12.7; p-value < 0.0001), International Knee Society (IKS) score (149.4 ± 11.9 vs. 179.4 ± 10.2; p-value < 0.0001), Knee Society Score [KSS, (54.2 ± 5.6 vs. 69.7 ± 12.7; p-value < 0.0001)], and Hospital for Special Surgery [HSS, (50.8 ± 3.3 vs. 64.8 ± 10.7; p-value < 0.0001)]. 42.5% patients showed excellent regeneration of femoral and 30.0% patients showed excellent regeneration of tibial cartilage in the medial compartment. CONCLUSION: By significantly alternating the knee biomechanics, HTO was found to unload the medial compartment leading to regeneration of the articular cartilage and significant improvement in patient's symptoms and quality of life. It is therefore recommended in the management of patients with arthritic changes limited to medial compartment only.
RESUMO
This prospective interventional study was planned to determine the clinical and radiological outcome of percutaneous iliosacral screw fixation for unstable pelvic ring injuries. It was conducted from March 2008 to June 2014 at the Department of Orthopaedic Surgery Combined Military Hospital (CMH) at Lahore, Multan, Rawalpindi and Muzaffarabad. It comprised 50 patients with unstable pelvic ring injuries. Visual analogue scale (VAS), Majeed pelvic score and Lindahl criteria were used for functional and radiological outcomes assessment. The mean age of the patients was 47.82±8.94 years. Moreover, 33(66%) participants were males and 17(34%) were females. The mean pre-operative Majeed and VAS scores were 38.98±6.28 and 9.04±0.67, respectively. Operating time and blood loss were reduced significantly. VAS score for post-operative pain was 3.82±1.26 at 1 month and decreased further to 2.68±1.30 at 12 months post-operatively (p<0.001). Radiological outcome and the post-operative Majeed scores were good to excellent in 43(86%) cases. Thus Percutaneous iliosacral screw fixation of unstable pelvic ring injuries resulted in excellent radiological and functional outcome with significantly decreased post-operative VAS score for SI joint pain.
